1. SPECIFIC ISSUES IN CONFLICT COUNTRIES The Case of DRC, Liberia & Sierra Leone By Paryss KOUTA

2. Eastern DRC

3. CONTEXT ANALYSIS DRC Divided into several parts and under diverse political and military authorities; Many cities are out of the control of the central power in Kinshasa; The armies do not have a homogenous command

4. DRC: SPECIFIC ISSUES  Persisting rumours on origin of vaccines  Rumours on the harmfulness of vaccines;  Difficulty in controlling such rumours;  Insufficient social mobilisation material;  Hasty and inadequate training of personnel and insufficient supervision ;  Absence of social mobilisation focal points in health zones;  Untrained personnel and lack of adequate support in social mobilisation;  No methodical and frequent monitoring and evaluation; DRC: SPECIFIC ISSUES  Persisting rumours on origin of vaccines  Rumours on the harmfulness of vaccines;  Difficulty in controlling such rumours;  Insufficient social mobilisation material;  Hasty and inadequate training of personnel and insufficient supervision ;  Absence of social mobilisation focal points in health zones;  Untrained personnel and lack of adequate support in social mobilisation;  No methodical and frequent monitoring and evaluation;

5. DRC: SPECIFIC ISSUES  Inadequate awareness of the population about AFPs;  Health personnel and clinicians less motivated about AFP surveillance;  Absence of education programmes on AFPs;  Existence of zones of insecurity in health zones  IEC not held at health centres;  Local authorities poorly involved; DRC: SPECIFIC ISSUES  Inadequate awareness of the population about AFPs;  Health personnel and clinicians less motivated about AFP surveillance;  Absence of education programmes on AFPs;  Existence of zones of insecurity in health zones  IEC not held at health centres;  Local authorities poorly involved;

6. DRC: SPECIFIC ISSUES  Non-existence of snacks to encourage and sustain the efforts of provincial social mobilisers;  Lack of support for AFP social mobilisation activities;  The continuation of the war in the above-indicated zones is delaying the optimization of efforts and therefore of expected results in this part of the country; DRC: SPECIFIC ISSUES  Non-existence of snacks to encourage and sustain the efforts of provincial social mobilisers;  Lack of support for AFP social mobilisation activities;  The continuation of the war in the above-indicated zones is delaying the optimization of efforts and therefore of expected results in this part of the country;

7.  It is impossible to fly directly from Kinshasa to Goma in Eastern DRC.  This journey increases the cost of interventions originating in the capital, Kinshasa, to the Eastern provinces;  Difficulty and high risks in undertaking missions towards villages around cities such as Goma, Bukavu and Kissangani, in view of the armed attacks which often cost the lives of the personnel (social mobilizers and vaccinators );  It is impossible to fly directly from Kinshasa to Goma in Eastern DRC.  This journey increases the cost of interventions originating in the capital, Kinshasa, to the Eastern provinces;  Difficulty and high risks in undertaking missions towards villages around cities such as Goma, Bukavu and Kissangani, in view of the armed attacks which often cost the lives of the personnel (social mobilizers and vaccinators );

8.  Virtual constant difficulty observed in most provinces for the development of a pertinent strategy that would help address the problem of the harmful effect of rumours in the war zones more methodically and rationally;  Missions between cities – that are even very close – are undertaken by air, which is the safest means of transport in this area;  Considerable negative weight of local authorities on the implementation of planned activities.  Virtual constant difficulty observed in most provinces for the development of a pertinent strategy that would help address the problem of the harmful effect of rumours in the war zones more methodically and rationally;  Missions between cities – that are even very close – are undertaken by air, which is the safest means of transport in this area;  Considerable negative weight of local authorities on the implementation of planned activities.

9.  The legal salaries paid to civil servants (including nurses, doctors, teachers and other professions) constitute a highly demoralizing factor which has a negative impact on the conducting of Polio/EPI/AFP activities.  Observation of fatigue among citizens who are reluctant to continue taking part in activities that require constant benevolent;  Serious risks of deadly attacks by military factions on social mobilizers and even on vaccinators responsible for house-to-house visits;  The legal salaries paid to civil servants (including nurses, doctors, teachers and other professions) constitute a highly demoralizing factor which has a negative impact on the conducting of Polio/EPI/AFP activities.  Observation of fatigue among citizens who are reluctant to continue taking part in activities that require constant benevolent;  Serious risks of deadly attacks by military factions on social mobilizers and even on vaccinators responsible for house-to-house visits;

10.  In view of the war or the above-mentioned risks related to the war, there are many sectors that are neither covered by routine EPI nor NIDs; suggesting the existence of many type “zero dose” children in Eastern DRC.

11. Lessons Learnt from Synchronised NIDs October- November 2000 SIERRA LEONE

12.  The Synchronised NIDs were jointly conducted in Sierra Leone, Liberia and Guinea i.e. the Mano River Union in October and November, 2000  The Synchronised NIDs went a long way to heal the then prevailing political rift between Sierra Leone and Liberia  However, the geographical /physical barriers posed a lot of accessibility constraints for the effective communication and social mobilisation to reach grassroots target groups within chiefdoms and boarder villages  The Synchronised NIDs were jointly conducted in Sierra Leone, Liberia and Guinea i.e. the Mano River Union in October and November, 2000  The Synchronised NIDs went a long way to heal the then prevailing political rift between Sierra Leone and Liberia  However, the geographical /physical barriers posed a lot of accessibility constraints for the effective communication and social mobilisation to reach grassroots target groups within chiefdoms and boarder villages

13.  There were exchanges of policy level officers and government ministers, which resulted in high level advocacy and cordiality among the countries to solve the issues of insecurity and political animosity  The synchronised NIDs posed a lot of social mobilisation planning and implementation problems and consumed a lot of funds and time for all stakeholders even as it did not permeate all communities  The most difficult problem faced by social mobilisation during the synchronised NIDs is the cross boarder war within the Mano River countries  There were exchanges of policy level officers and government ministers, which resulted in high level advocacy and cordiality among the countries to solve the issues of insecurity and political animosity  The synchronised NIDs posed a lot of social mobilisation planning and implementation problems and consumed a lot of funds and time for all stakeholders even as it did not permeate all communities  The most difficult problem faced by social mobilisation during the synchronised NIDs is the cross boarder war within the Mano River countries

14.  The war prohibited travelling and physical contacts with communication counterparts in the respective communities within the affected countries  Children in the rebel held areas could not get immunisation, as social workers and communicators did not get access or allowed to enter in all those areas  Very little immunisation took place in rebel control areas. This led to fresh negotiations with rebel leaders to organise special Sub NIDs in those areas, which was agreed upon and a successful two rounds of SNIDs took place in those areas  The war prohibited travelling and physical contacts with communication counterparts in the respective communities within the affected countries  Children in the rebel held areas could not get immunisation, as social workers and communicators did not get access or allowed to enter in all those areas  Very little immunisation took place in rebel control areas. This led to fresh negotiations with rebel leaders to organise special Sub NIDs in those areas, which was agreed upon and a successful two rounds of SNIDs took place in those areas

15.  There is a huge language barrier among the peoples of Mano River countries and this poses a serious hindrance for message dissemination and co-ordination/linkage  Roadworthy vehicles and the number of personnel for widespread effective sensitisation and community participation fell far short of the requirement for the smooth running of the programme  There is a huge language barrier among the peoples of Mano River countries and this poses a serious hindrance for message dissemination and co-ordination/linkage  Roadworthy vehicles and the number of personnel for widespread effective sensitisation and community participation fell far short of the requirement for the smooth running of the programme

16. Lessons Learnt from Synchronised NIDs LIBERIA

17. *The effective Monitoring & Evaluation of the communication plan has been a challenge for several resaons  Because of the fluid security situation,  the lack of adequate trained manpower,  The communication team has not been able to gather, compile and report on the exact number of children vaccinated either during NIDs or routine immunization *The effective Monitoring & Evaluation of the communication plan has been a challenge for several resaons  Because of the fluid security situation,  the lack of adequate trained manpower,  The communication team has not been able to gather, compile and report on the exact number of children vaccinated either during NIDs or routine immunization

18. *Synchronized NIDs for now is elusive in the Mano River Basin for the obvious reason of war  The launch of the first Synchronized NIDs at the Mano River Bridge between Liberia and Sierra Leone was attended by Liberia and Sierra Leone, but boycotted by Guinea  Since that time, the deteorating security situation in the three countries makes Synchronized NIDs unthinkable for now *Synchronized NIDs for now is elusive in the Mano River Basin for the obvious reason of war  The launch of the first Synchronized NIDs at the Mano River Bridge between Liberia and Sierra Leone was attended by Liberia and Sierra Leone, but boycotted by Guinea  Since that time, the deteorating security situation in the three countries makes Synchronized NIDs unthinkable for now

19. sAccessing all parts of the country is also a challenge:  Lack of roads, and where there are roads, they are in very bad conditions and do not reach remote areas have all retarded high coverage  Finally, the need to move communication planners and social mobilizer from the traditional approach of "throwing" information at local people to a people based participatory approach focussing on overcoming behavioral barriers to promoting desired behavior is a major challenge sAccessing all parts of the country is also a challenge:  Lack of roads, and where there are roads, they are in very bad conditions and do not reach remote areas have all retarded high coverage  Finally, the need to move communication planners and social mobilizer from the traditional approach of "throwing" information at local people to a people based participatory approach focussing on overcoming behavioral barriers to promoting desired behavior is a major challenge